Uterine Growths (cont.)

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

How are uterine fibroids diagnosed?

Fibroids are diagnosed by performing a manual pelvic examination (bimanual
examination) and confirmed by
ultrasound. Ultrasound is harmless and does not
involve radiation exposure. This test is similar to the one performed in
pregnant women to view the developing
fetus inside the uterus. Rarely, more
complex imaging is used, but only in cases wherein the doctor cannot determine
the exact nature of the mass found on the physical exam or ultrasound.

What is the treatment for uterine fibroids?

Reasons for surgical removal of uterine fibroids

Some of the reasons for surgical removal of uterine fibroids include:

If there is still concern that the uterine growth could be cancer: In
these cases, the doctor is not certain that the growth is actually a benign
fibroid. Unusually rapid growth is a sign that a uterine growth may be
cancerous. The growth must be removed and examined by a pathologist for signs of more
dangerous conditions.

If other pelvic surgery is already being done: There are other reasons for
pelvic surgery, such as ovarian disease.

If all medical treatments have failed to stop bleeding or other complications.

Surgery for uterine fibroids

Hysterectomy: Removal of the uterus is called a
hysterectomy. Fibroids are
the most common reason that hysterectomies are performed in the United States.
Advantages are that: (1) the fibroids never return (the only "cure" for
fibroids); (2) the woman will never have another menstrual period (which some,
but not all women, find to be an advantage); and (3) contraception is no longer
a concern. It is easy to understand, therefore, that the best candidates for
hysterectomy have already finished their childbearing.

Myomectomy (Local Resection): This surgery involves the removal of the
fibroids themselves without removal of the whole uterus. Myomectomy is not
permanent in the sense that fibroids can grow back after the procedure. The
fibroids grow back in about 25% to 50% of women, and about 10% of women will need
a second surgery. Although myomectomy is a sure temporary measure, it is less
guaranteed to be a permanent solution. Thus, this procedure is often used to
"buy time" if the woman is
planning to become pregnant in the next few years.
The advantages of this surgery are that it preserves the uterus for childbearing
and involves less extensive surgery, which implies less extensive recovery
periods. Certainly, in the short term, bleeding tends to be much improved after
myomectomy (in about 80% of women).

Embolization: Another technique for treating fibroids is known as uterine artery embolization (UAE). This technique uses small beads of a compound called polyvinyl alcohol, which are injected through a catheter into the arteries that
supply the fibroid. These beads obstruct the blood supply to the fibroid and starve it of blood and oxygen. Uterine artery occlusion (UAO), which involves clamping the involved uterine arteries as opposed to injecting the polyvinyl alcohol beads, has also been used as a way to interrupt blood supply to the fibroid.

Other Procedures: Some treatments have involved boring holes into the
fibroid with laser fibers, freezing probes (cryosurgery), and other destructive
techniques that do not actually remove the tissue but try to destroy it in
place.

Complications uterine fibroid surgery

It might seem very appealing to a woman to just have the uterus removed,
however, as with any surgery, complications can include a risk (though extremely low)
of dying or having complications from the general anesthesia. There are also risks of bleeding and infection,
although these risks are fairly low. However, a hysterectomy is actually a more
significant procedure than many women realize in that it does require
substantial recovery time.